Chronic Kidney Disease (CKD) | Kidney Failure

Symptoms

Many people with chronic kidney disease (CKD) will not have symptoms because it does not usually cause problems until it reaches an advanced stage.

Early stages of CKD

Kidney disease does not tend to cause symptoms when it's at an early stage. This is because the body is usually able to cope with a significant reduction in kidney function.

Kidney disease is often only diagnosed at this stage if a routine test for another condition, such as a blood or urine test, detects a possible problem.

If it's found at an early stage, medicine and regular tests to monitor it may help stop it becoming more advanced.

Later stages of CKD

A number of symptoms can develop if kidney disease is not found early or it gets worse despite treatment.

Symptoms can include:

• weight loss and poor appetite
• swollen ankles, feet or hands – as a result of water retention (oedema)
• shortness of breath
• tiredness
• blood in your pee (urine)
• an increased need to pee – particularly at night
• difficulty sleeping (insomnia)
• itchy skin
• muscle cramps
• feeling sick
• headaches
• erectile dysfunction in men

This stage of CKD is known as kidney failure, end-stage renal disease or established renal failure. It may eventually require treatment with dialysis or a kidney transplant.

Causes

Chronic kidney disease is usually caused by other conditions that put a strain on the kidneys. Often it's the result of a combination of different problems.

CKD can be caused by:

• high blood pressure – over time, this can put strain on the small blood vessels in the kidneys and stop the kidneys working properly
• diabetes – too much glucose in your blood can damage the tiny filters in the kidneys
• high cholesterol – this can cause a build-up of fatty deposits in the blood vessels supplying your kidneys, which can make it harder for them to work properly
• kidney infections
• glomerulonephritis – kidney inflammation
• autosomal dominant polycystic kidney disease – an inherited condition where growths called cysts develop in the kidneys
• blockages in the flow of urine – for example, from kidney stones that keep coming back, or an enlarged prostate
• long-term, regular use of certain medicines – such as lithium and non-steroidal anti-inflammatory drugs (NSAIDs)

You can help prevent CKD by making healthy lifestyle changes and ensuring any underlying conditions you have are well controlled.

Diagnosis

Chronic kidney disease (CKD) can be diagnosed with blood and urine tests.

In many cases, CKD is only found when a routine blood or urine test you have for another problem shows that your kidneys may not be working normally.

Who should be tested for CKD?

See a GP if you have persistent symptoms of CKD, such as:

• weight loss or poor appetite
• swollen ankles, feet or hands (oedema)
• shortness of breath
• tiredness
• blood in your pee (urine)
• peeing more than usual, particularly at night

The GP can look for other possible causes and arrange tests if necessary.

Because CKD often has no symptoms in the early stages, some people at a higher risk should be tested regularly.

Regular testing is recommended if you have:

• high blood pressure
• diabetes
• acute kidney injury – sudden damage to the kidneys that causes them to stop working properly
• cardiovascular disease – conditions that affect the heart, arteries and veins, such as coronary heart disease or heart failure
• other conditions that can affect the kidneys – such as kidney stones, an enlarged prostate or lupus
• a family history of advanced CKD or an inherited kidney disease
• protein or blood in your urine where there's no known cause

Children and young people with one working kidney should also be tested regularly.

You're also more likely to develop kidney disease if you're black or of south Asian origin.

People taking long-term medicines that can affect the kidneys, such as lithium, omeprazole or non-steroidal anti-inflammatory drugs (NSAIDs), should also be tested regularly.

Talk to the GP if you think you may need regular testing for kidney disease.

Tests for CKD

Blood test

The main test for kidney disease is a blood test. The test measures the levels of a waste product called creatinine in your blood.

A doctor uses your blood test results, plus your age, size, and gender to calculate how many millilitres of waste your kidneys should be able to filter in a minute.

This calculation is known as your estimated glomerular filtration rate (eGFR).

Healthy kidneys should be able to filter more than 90ml/min. You may have CKD if your rate is lower than this.

Urine test

A urine test is also done to:

• check the levels of substances called albumin and creatinine in your urine – known as the albumin:creatinine ratio, or ACR
• check for blood or protein in your urine

Alongside your eGFR, urine tests can help give a more accurate picture of how well your kidneys are working.

Other tests

Sometimes other tests are also used to assess the level of damage to your kidneys.

These may include:

• an ultrasound scan, MRI (Magnetic resonance imaging) scan or CT (computed tomography) scan – to see what the kidneys look like and check whether there are any blockages 
• a kidney biopsy – a small sample of kidney tissue is removed and the cells are examined under a microscope for signs of damage

Test results and stages of CKD

Your test results can be used to determine how damaged your kidneys are, known as the stage of CKD.

This can help your doctor decide the best treatment for you and how often you should have tests to monitor your condition.

Your eGFR results is given as a stage from 1 of 5:

• stage 1 (G1) – a normal eGFR above 90ml/min, but other tests have detected signs of kidney damage
• stage 2 (G2) – a slightly reduced eGFR of 60 to 89ml/min, with other signs of kidney damage
• stage 3a (G3a) – an eGFR of 45 to 59ml/min
• stage 3b (G3b) – an eGFR of 30 to 44ml/min
• stage 4 (G4) – an eGFR of 15 to 29ml/min
• stage 5 (G5) – an eGFR below 15ml/min, meaning the kidneys have lost almost all of their function

Your ACR result is given as a stage from 1 to 3:

• A1 – an ACR of less than 3mg/mmol
• A2 – an ACR of 3 to 30mg/mmol
• A3 – an ACR of more than 30mg/mmol

For both eGFR and ACR, a higher stage indicates more severe kidney disease.

Treatment Options

There's no cure for CKD, but treatment can help relieve the symptoms and stop it getting worse. Your treatment will depend on how severe your condition is.

The main treatments are:

• lifestyle changes to help you remain as healthy as possible
• medicine to control associated problems such as high blood pressure and high cholesterol
• dialysis – treatment to replicate some of the kidney's functions; this may be necessary in advanced CKD
• kidney transplant – this may also be necessary in advanced CKD

You'll also be advised to have regular check-ups to monitor your condition.

Prevention Tips

Chronic kidney disease (CKD) cannot always be prevented, but you can take steps to reduce the chances of getting the condition.

Following the advice below can reduce your risk.

Manage underlying conditions

If you have a long-term condition that could lead to CKD, such as diabetes or high blood pressure, it's important this is managed carefully.

Follow the advice of your GP, take any medicine you're prescribed and keep all appointments relating to your condition.

Stop smoking

Smoking increases your risk of cardiovascular disease, including heart attacks or strokes, which is associated with a higher risk of CKD.

Stopping smoking will improve your general health and reduce your risk of these serious conditions

Healthy diet

A healthy, balanced diet can reduce your risk of kidney disease by keeping your blood pressure and cholesterol at a healthy level.

A balanced diet should include:

• plenty of fruit and vegetables – aim for at least 5 portions a day
• meals that include starchy foods, such as potatoes, wholegrain bread, rice or pasta
• some dairy or dairy alternatives
• some beans or pulses, fish, eggs, or meat as a source of protein
• low levels of saturated fat, salt and sugar

You may also be given advice about dietary changes that can specifically help with kidney disease, such as limiting the amount of potassium or phosphate in your diet.

Manage alcohol intake

Drinking excessive amounts of alcohol can cause your blood pressure and cholesterol levels to rise to unhealthy levels.

Sticking to the recommended alcohol limit is the best way to reduce your risk:

• men and women are advised not to regularly drink more than 14 units a week
• spread your drinking over 3 days or more if you drink as much as 14 units a week

Exercise regularly

Regular exercise should help lower your blood pressure and reduce your risk of developing kidney disease.

At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity, such as cycling or fast walking, every week is recommended, as well as strength exercises on 2 or more days a week that work all the major muscles (legs, hips, back, abdomen, chest, shoulders and arms).

Be careful with painkillers

Kidney disease can be caused by taking too many non-steroidal anti-inflammatories (NSAIDs), such as aspirin and ibuprofen, or taking them for longer than recommended.

If you need to take painkillers, make sure you follow the instructions that come with the medicine.

When To See A Doctor

See a GP if you have persistent or worrying symptoms that you think could be caused by kidney disease.

The symptoms of kidney disease can be caused by many less serious conditions, so it's important to get a proper diagnosis.

If you do have CKD, it's best to get it diagnosed as soon as possible. Kidney disease can be diagnosed by having blood and urine tests.